Let’s not ‘medicalise and disorderise’ young people, let’s listen to them

A note from Mad in Ireland: There has been a lot in the media recently about youth mental health and how young people are increasingly in crisis and that we are facing a ‘tsunami’ of mental health challenges in young people. This interview brings another perspective to this and warns that we cannot continue to ‘medicalise and disorderise,’ young people who are experiencing understandable and natural reactions to what’s going on in their lives. Read the excellent interview, conducted by Dr Emma Farrell in full here:

Dr Cian Aherne is a Clinical Psychologist and Clinical Manager of Jigsaw Limerick. JIGSAW, Ireland’s National Centre for Youth Mental Health, is an early intervention mental health service for young people aged 12-25.

Dr Emma Farrell spoke to Cian about his career, why and how he became a psychologist, and his views on the reported crisis in youth mental health. In his own words, “Lets listen to our young people, what they have to say [and] try and understand it, rather than panicking ourselves and getting into disorder mode and solution mode. Young people are incredibly resilient.”

Emma Farrell: Cian, I wonder if we could start off by telling me a little about how you became a clinical psychologist?

Cian Aherne: So I didn’t set out to be a psychologist. I set out to be a Rugby player. Sport was all I ever cared about growing up. When doing my Leaving Cert I was thinking of doing sports science, and then I just picked psychology because I thought oh, I could veer into sports psychology, if needs be. It was only when the professional rugby career derailed that I reassessed my options. Embarrassingly, or shamefully maybe, my then girlfriend, now wife, was setting out to become a clinical psychologist, and my dad was a clinical psychologist, so I think part of me found comfort in known territory. I just wanted to do something meaningful. I was, kind of, burned by the rugby career and had been thinking there wasn’t a whole lot of meaning to it, it was a selfish career, so I wanted to embark on something more selfless. I wanted to help other people.

I started off thinking, ‘Oh, I’ll get out to this course by just being me and showing them that I’m a nice guy’, and then, realising by the end of the ten interviews, that it was actually the fact that I had a couple of publications on my CV.

Emma Farrell: Did you say that in the interview to get on a clinical psychology programme?!

Cian Aherne: Which interview?! I had 10 interviews before I finally got on a course. After flying around the UK and Ireland, I ended up at home (in the University of Limerick). I don’t think that they [the DClin interview panel] put too much of an emphasis on ‘Why’. I started off thinking, ‘Oh, I’ll get out to this course by just being me and showing them that I’m a nice guy’, and then, realising by the end of the ten interviews, that it was actually the fact that I luckily had, somehow, a couple of publications on my CV… I think things like that had a lot more currency.

Emma Farrell: I think you’re probably downplaying your own role in it too, but it often strikes me that the things you need to get into clinical psychology, and the things you need to be a good psychologist, are not necessarily the same things.

Cian Aherne: I’d probably go a step further and say, for me certainly, I don’t even know if the things I learned in training are the things that I put much emphasis on in my job!

Emma Farrell: And what would you say are the things that make you good at your job?

Cian Aherne: I think that the things that are most important to be a good clinical psychologist are kindness, being able to develop relationships, being a bit of fun, being caring, being able to sit with, and listen to, difficult emotions. Being gentle, respectful, collaborative. I know some of those things can sound like buzzwords but I don’t think that much of [these qualities] were emphasised in my 3 years training, or the interview process before it. I think that all of that tended to be more professional, expert, kind of, specifics. which I don’t know if I use any of that stuff much anymore.

I think that the things that are most important to be a good clinical psychologist are kindness, being able to develop relationships, being a bit of fun, being caring, being able to sit with, and listen to, difficult emotions.

Emma Farrell: One of the things we hear a lot, particularly in the media, is that there are very high rates of mental distress and disorder amongst young people today. This narrative seems to have only increased, the proportions appear to have increased, since the pandemic. In your experience, working in a youth mental health service for many years now, are young people more mentally unwell? Are they struggling more than previous generations?

Cian Aherne: I think this is a tricky discussion to have because I’m probably bringing in a lot of my own emotion and bias. So that’s the caveat before I get into my general impression, but I’m allowed to have an opinion as well! I totally and utterly disagree with this idea that young people are less resilient, or getting less resilient, or experiencing more distress. We’ve spent 10 years asking and trying to develop a country where young people are more willing to speak about their vulnerabilities, to talk about emotions, to learn about their emotions and now they’re turning around and telling us all about their emotions, and we’re going. “Oh, my God! You’re all so sad!”, you know “this is terrible!”. It’s like, no, actually, this is a really good sign. This is what we want. This is what’s been repressed and blocked for decades. Let’s listen to young people. That’s the most important thing. There’s no point on getting hung up on this ‘tsunami’ of youth mental health problems. I think all that serves to do is medicalise, disorderise, ‘other’, people who express distress or emotional challenges. Like, I think it’s great! We’ve started a conversation. We’ve started a discussion. Now let’s sit with that. Listen to our young people, what they have to say [and] try and understand it, rather than panicking ourselves now and getting into disorder mode and solution mode. Young people are incredibly resilient. I think of the heroes that come into our rooms every day; it’s just mind-blowing what people survive.

I totally and utterly disagree with this idea that young people are less resilient, or getting less resilient, or experiencing more distress. We’ve spent 10 years asking and trying to develop a country where young people are more willing to speak about their vulnerabilities, to talk about emotions, and now they’re turning around and telling us all about their emotions, and we’re going. “Oh, my God! You’re all so sad!”, you know, “this is terrible!”. No, actually, this is a really good sign.

We were talking about my career trajectory earlier and that’s what I get embarrassed about. My late teens and early twenties, I hadn’t a clue. I did not have a clue what people were going through. You see people in secondary school, in college, and because you don’t have any kind of knowledge of their interior lives or what they’ve experienced, you just kind of think “why aren’t they getting on with things?”. I look back now and I’m like, “Oh My God, what people must have been going through?”. I just had no idea. No understanding. When you see it now, these people are just absolute heroes. Going through trauma after trauma after trauma and still standing and then beating themselves up for not having a “successful leaving cert”. So, to turn around and say, young people have no resilience or to just hold negative views on young peoples’ abilities, yeah, that gets me very frustrated.

Emma Farrell: I often struggle, as a chartered psychologist, with the tendency of psychology to offer quite reduced, mechanistic, simplistic, understandings of vulnerability and distress and behaviours that can be, from my perspective at least, quite advanced, quite adaptive and quite functional ways of coping with impossible situations and impossible lives and impossible worlds. I think this is why I’m drawn to scholars and clinicians like you who are using their positions and influence in psychology to offer nuance and to affect change in a meaningful way.

Cian Aherne: I don’t know it. It kills me the way psychologists, psychiatrists, professionals in general, use our influence and power in ways that, to me, sometimes seem really quite harmful and quite paradoxical to what’s needed. I was at a psychology conference recently and it was all professionals and shirts and ties, and the languages of disorder and diagnosis and assessment and expertise, and everyone was talking about the DSM and categories and talking about people without them being there. I couldn’t stomach it. Two weeks later I was at a conference where all aspects of humanity – service users, people from all disciplines – were there. It was free, where the professional conference was hundreds of euros, and I just got so much more from being around humans being humans. Not being experts and shrouding ourselves in this, kind of, cloak of expertise because it’s too anxiety provoking to not be certain about things or to not profess this kind of view of ourselves as “professional”, as “expert”. I think psychologists want to believe that we are a science, we can control outcomes, and if people would just listen to our recommendations that they’d feel happier and feel better. I’ve at times seen a total disregard for systemic influences and things way beyond our control and the human experience itself. No matter how many bell curves you show, and no matter how broad the evidence base, human experiences vary and are unique from person to person. Everyone’s got a very different, unique, special, interesting story that to make sense of each one takes so much more than any stats or categories. I feel like going against this, kind of, common narrative of expertise and skill base and training and CPD, and saying ‘stop’. Stop painting some picture of ourselves to earn more money or make ourselves feel more professional or expert. It’s actually just being with someone. Just be kind. Just listen. Just listen, shut up and listen. And leave our…I say this but I’m not able to do this…leave our egos at the door. Be humble. Listen to the person. Actually put stock in what they have to say. Don’t be just sitting there waiting to put in your professional opinion on what’s going on. That’s what’s helpful. That’s what people are looking for. They’re not looking for solutions. Any time I’ve ever put myself in the position of trying to give solutions or trying to give CBT or practical coping skills, or whatever. People say they want that, people ask for that, but people don’t do those things. I’m so shocked by this CBT evidence base, who are these people? I try to give people CBT homework exercises and maybe one in every thirty does them! Is one per cent enough to get an evidence base? Because people only do what people want to do so me trying to control them is just… . Maybe I’m just the worst CBT therapist ever. I like CBT, it is really helpful for lots of people. I get the mechanism behind it, but I also believe the core of CBT is the relationships. If you get on well with someone. If the young person respects you and is in a place where they’re ready to try and do that kind of work, then it works. But it’s not because of the CBT itself.

I think psychologists want to believe that we are a science, we can control outcomes, and if people would just listen to our recommendations that they’d feel happier and feel better. I’ve at times seen a total disregard for systemic influences and things way beyond our control and the human experience itself.

Emma Farrell: I think the only thing I’ve ever been good at, although perhaps I’m not very good at it right now, is just listening. If, as you say, you can leave your ego at the door, and silence yourself and your inner world enough to just be with someone who can, then, carefully and safely open up their whole world. There aren’t many places in which we can do that. Without being interrupted, without being, yeah, curtailed in all of the different ways we do that as people, and just how powerful that experience is in and of itself is. We can’t quantify that.

Cian Aherne: I think of all the training I’ve done, all the jobs I’ve been in, all those events I’ve attended, the one that has stood to me more than anything actually happened earlier in my career. It was Samaritan’s training. Just active listening, how to listen. It sounds so rudimentary at times, yet it’s the most powerful thing. The most powerful skill I’ve ever been given.

This interview conducted by Dr Emma Farrell first appeared thinkful.ie and has been reposted with permission.